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Gastrointestinal Medications

From the Walter Reed Army Medical Center, Washington, DC, and the Dept. of Psychiatry, Univ. of Maryland Medical System. Dr. Sandson is Clinical Assistant Professor in the Dept. of Psychiatry at the Univ. of Maryland Medical System and Director of the Division of Education and Residency Training for the Sheppard Pratt Health System. He currently directs the Sheppard Pratt Psychopharmacology Consultation Service. Dr. Cozza is the staff psychiatrist for the Infectious Disease Service, Dept. of Medicine, Walter Reed Army Medical Center, Washington, DC, and is Assistant Professor of Psychiatry, Uniformed Services Univ. of Health Sciences, Bethesda, MD. Dr. Cozza is co-author, along with Drs. Scott C. Armstrong and Jessica R. Oesterheld, of The Concise Guide to Drug Interaction Principles for Medical Practice (American Psychiatric Publishing, Inc., 2003). Send correspondence and reprint requests to Gary H. Wynn, M.D., Dept. of Psychiatry, Walter Reed Army Medical Center, Washington, DC. e-mail: ghwynn{at}gmail.com

Medications to address gastrointestinal disorders are among the most commonly dispensed somatic medications. The authors examine proton pump inhibitors, H₂ blockers, 5-HT₃ receptor-antagonists, and a few other drugs that are used to address this domain of medical concerns. The metabolic pathways, interactions with the P-glycoprotein transporter, and capabilities of inhibiting or inducing metabolic enzymes are elucidated for each drug. Specific drug–drug interactions with each agent are also detailed, including both psychotropic and non-psychotropic agents. Also, the article explores how different genotypic variants for specific cytochrome P450 enzymes have an impact on the effectiveness and likelihood of drug–drug interactions relating to specific gastro-intestinal medications.

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